Infertility threatens the love and harmony of a home. Many couples are faced with the unimaginable agony of childlessness.
The desire of most couples in Nigeria is to become parents within the first or second year of marriage.
While many have it fulfilled, a large number are still battling with the challenge of infertility. In spite of their efforts, a lot of people have had their hopes dashed. And when pregnancy is not achieved at a point, mistrust sets in the relationship. Most of the time, the woman bears the brunt of it all.
It is estimated that 40 to 45% of all consultations in gynecological clinics are infertility–related. Oftentimes, men are uncomfortable and embarrassed to talk about it and also not willing to submit to fertility checks in the clinic for fear and shame of people knowing their problems because of ego. Cultural inhibitions are responsible for this, too, as it is a behavioral pattern of typical African men
The major causes of male infertility are genetic, physical abnormalities, infection of the genital tracts while others can be traced to environmental factors such as heat, toxins and chemicals. Researchers have also found out that sitting down for long periods and wearing tight clothing may increase the temperature in the scrotum resulting in slight reduction of sperm quality.
Again, a person’s health and lifestyle have also been found to affect male sperm quality, while other causes such as drugs use, alcohol and tobacco smoking also may affect male fertility.
Emotional stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count and sperm quality.
The most common problem of these factors manifest relates to sperm production in both quantity and quality.
Often, men are uncomfortable and embarrassed to talk about it and are also not willing to submit to fertility checks in the clinic for fear and shame of people knowing their problems because of ego. Cultural inhibitions are also responsible for this, as it is a behavioral pattern of typical African men.
Now, all these challenges of testing are over.
The SwimCount Sperm Quality Test is here to their rescue. The SwimCount Sperm Quality Test is a revolution and a pre-screening device for the early diagnosis of male infertility. It is the first test that takes into account not only the concentration but also the Progressive Motility of the Sperm Cells (PMSCs) which is the only sperm that can fertilize an egg.
SwimCount is a home sperm test kit which measures the sperm quality as well as quantity. Thus, SwimCount is a more complete first diagnosis of PMSCs.
Until now, the male fertility tests only took into account the quantity of sperm and not the quality, although other factors, such as Progressive Motility – their ability to move forward in a straight line -are more important for fertilization, for which only a single sperm of optimal quality is necessary. In other words, a Progressive Motile Sperm Cell is the only sperm cell that can fertilize the egg.
It is a medical breakthrough with a test that allows men to obtain an early diagnosis with a high degree of reliability in the comfort of their own home.
In obtaining the sperm sample, you must never use the normal condom as it is laced with chemicals that prevent pregnancy. SwimCount therefore comes with a non-spermicide condom. The advantage of this is that the sperm specimen is collected after the sex act (saving the African man the embarrassment of obtaining the specimen through masturbation).
The technology behind SwimCount is based on the same principle as the well-known Swim-Up Technology and thereby measuring the number of PMSCs.
After depositing a small amount of liquefied semen sample into the device and the semen compartment, the semen cells that are able to move progressively and swim up into the Swim Up compartment are then stained blue and drawn into the Result Window. In this way, the darker the color, the more PMSCs are present in the sample, which is seen after 30 minutes.
The threshold of male fertility by SwimCount is set at a count of more than 5 million PMSCs per mL (following the WHO criteria, 5th ed., 2010).
A lower number than 5 million PMSCs/mL implies greater difficulties to obtain a natural pregnancy within a period of one year, so it is advisable to consult a reproductive specialist.
Homebased device for semen analysis-SwimCount
With about 70 million cases of infertility worldwide, half of which are caused by male factors, sperm analysis is critical to determine male fertility potential. Conventional semen analysis methods involve complex and manual inspection with a microscope, and these methods are labor intensive and can take several days. Due to unavailability of rapid, convenient, and user-friendly semen analysis tools, many men do not seek medical evaluation, especially in resource-constrained settings. Furthermore, as conventional methods have to be conducted in the laboratories, many men are unwilling to be tested as a result of social stigma in certain regions of the world. One solution can be found in at-home sperm analysis, which allows men to test their semen without the hassle of going to and paying for a clinic. Around 40–50% of the 70 million cases of infertility worldwide are caused by male factors.
Male infertility is caused by abnormal characteristics in several parameters, including sperm motility, morphology, velocity, semen volume, sperm concentration, and sperm count. To determine male fertility potential, sperm analysis of these main parameters is necessary. Each of these parameters can be assessed through standard sperm analysis methods using microscopes and counting chambers. Motility is scored by evaluating each individual spermatozoa in a given sample, counting the numbers of progressive, non-progressive, and immotile spermatozoa, and comparing the values to find an average percentage of motility.
As these conventional sperm analysis methods involve complex, manual inspection with a microscope, they are labor intensive and can take several days. Additionally, the results of these methods are subjective and prone to human error. Other methods, such as computer-assisted semen analysis (CASA), which uses algorithms to automatically track spermatozoa, are also effective and are able to present qualitative information on sperm motility. However, CASA based methods still have to use large, expensive, and high maintenance equipment, which hinders widespread use. Both traditional methods and CASA are also limited by small field of view, which prevents large numbers of spermatozoa being analyzed at the same time. Furthermore, as both methods have to be conducted in the laboratories, many men are unwilling to be tested as a result of social stigma in certain regions of the world. Conversely, at-home analysis of male fertility is a cost-effective, private, and rapid solution to male fertility based inquiries, making it beneficial to men who are hesitant to seek medical evaluation. Most at-home systems will provide rudimentary analysis of a sample, giving the person an idea of whether or not to pursue further testing.
STANDARD SEMEN ANALYSIS
The World Health Organization (WHO) has set standards for Sperm Analysis in WHO Laboratory Manual (WHO, 2010). According to WHO, the motility of sperm cells is categorized into three types of movement, progressive motility (PR), non-progressive motility (NP), and immotility (IM). Progressive motility is defined by active motion in a large circular pattern or in a forward linear pattern and is not dependent on speed, while nonprogressive motility is defined by movement without progression. Immotility is defined by no observable movement. While total motility has a lower reference limit of 40%, progressive motility has a lower reference limit of 32% (WHO, 2010).
Comparing the results of different studies, the concentration of progressively motile spermatozoa seems to be the most predictive factor regarding outcome, but, still, no individual parameter can be considered single best predictor of fertility.
SwimCount Sperm Quality Test-How to use the Device
SwimCount Sperm Quality Test is a home-based kit that tests the concentration of progressively motile sperm cells. The kit includes a collection cup, a syringe, instructions for use, and the device itself. Users collect a sample in collection cup, wait for about 30 min, stir the sample ten times with the syringe, collect 0.5 mL of the sample with the syringe, and transfer it to the device. As an add-on, users also get the SwimCount Non-Spermicide Condom to collect the sample. Then, a slider on the side must be pushed forward to activate the device, which has three chambers: the sample chamber in which the semen is deposited by the user, the separation chamber to which only progressively motile spermatozoa can swim into, and finally, the detection and result window to which the progressively motile spermatozoa, now stained with dye, are captured onto. After another 30 min and pulling the slider back, the results are interpreted by the final color in the results window compared to the reference colors printed next to the window on the device. If similar to the lightest color, the concentration is below 5 million motile sperm/mL. If similar to the darkest color, the concentration is above 20 million motile sperm/mL. If similar to the middle color, the concentration is in between the other values, near at the normal level for fertile men according to WHO. SwimCount Sperm Quality Test has an accuracy of 95% compared to manual microscope methods.
Up to 15 percent of couples are infertile. This means they aren’t able to conceive a child even though they’ve had frequent, unprotected sexual intercourse for a year or longer. In up to half of these couples, male infertility plays a role.
Male infertility is due to low sperm production, abnormal sperm function or blockages that prevent the delivery of sperm. Illnesses, injuries, chronic health problems, lifestyle choices and other factors can play a role in causing male infertility.
Not being able to conceive a child can be stressful and frustrating, but a number of male infertility treatments are available.
Symptoms
The main sign of male infertility is the inability to conceive a child. There may be no other obvious signs or symptoms. In some cases, however, an underlying problem such as an inherited disorder, hormonal imbalance, dilated veins around the testicle, or a condition that blocks the passage of sperm causes signs and symptoms.
Although most men with male infertility do not notice symptoms other than inability to conceive a child, signs and symptoms associated with male infertility include:
Problems with sexual function — for example, difficulty with ejaculation or small volumes of fluid ejaculated, reduced sexual desire or difficulty maintaining an erection (erectile dysfunction)
Pain, swelling or a lump in the testicle area
Recurrent respiratory infections
Inability to smell
Abnormal breast growth (gynecomastia)
Decreased facial or body hair or other signs of a chromosomal or hormonal abnormality
Having a lower than normal sperm count (fewer than 15 million sperm per milliliter of semen or a total sperm count of less than 39 million per ejaculate)
When to see a doctor
See a doctor if you have been unable to conceive a child after a year of regular, unprotected intercourse or sooner if you have any of the following:
Have erection or ejaculation problems, low sex drive, or other problems with sexual function
Have pain, discomfort, a lump or swelling in the testicle area
Have a history of testicle, prostate or sexual problems
Have had groin, testicle, penis or scrotum surgery
Request an Appointment at Mayo Clinic
Causes
Male fertility is a complex process. To get your partner pregnant, the following must occur:
You must produce healthy sperm. Initially, this involves the growth and formation of the male reproductive organs during puberty. At least one of your testicles must be functioning correctly, and your body must produce testosterone and other hormones to trigger and maintain sperm production.
Sperm have to be carried into the semen. Once sperm are produced in the testicles, delicate tubes transport them until they mix with semen and are ejaculated out of the penis.
There needs to be enough sperm in the semen. If the number of sperm in your semen (sperm count) is low, it decreases the odds that one of your sperm will fertilize your partner’s egg. A low sperm count is fewer than 15 million sperm per milliliter of semen or fewer than 39 million per ejaculate.
Sperm must be functional and able to move. If the movement (motility) or function of your sperm is abnormal, the sperm may not be able to reach or penetrate your partner’s egg.
Medical causes
Problems with male fertility can be caused by a number of health issues and medical treatments. Some of these include:
Varicocele. A varicocele is a swelling of the veins that drain the testicle. It’s the most common reversible cause of male infertility. Although the exact reason that varicoceles cause infertility is unknown, it may be related to abnormal testicular temperature regulation. Varicoceles result in reduced quality of the sperm.
Treating the varicocele can improve sperm numbers and function, and may potentially improve outcomes when using assisted reproductive techniques such as in vitro fertilization.
Infection. Some infections can interfere with sperm production or sperm health or can cause scarring that blocks the passage of sperm. These include inflammation of the epididymis (epididymitis) or testicles (orchitis) and some sexually transmitted infections, including gonorrhea or HIV. Although some infections can result in permanent testicular damage, most often sperm can still be retrieved.
Ejaculation issues. Retrograde ejaculation occurs when semen enters the bladder during orgasm instead of emerging out the tip of the penis. Various health conditions can cause retrograde ejaculation, including diabetes, spinal injuries, medications, and surgery of the bladder, prostate or urethra.
Some men with spinal cord injuries or certain diseases can’t ejaculate semen, even though they still produce sperm. Often in these cases sperm can still be retrieved for use in assisted reproductive techniques.
Antibodies that attack sperm. Anti-sperm antibodies are immune system cells that mistakenly identify sperm as harmful invaders and attempt to eliminate them.
Tumors. Cancers and nonmalignant tumors can affect the male reproductive organs directly, through the glands that release hormones related to reproduction, such as the pituitary gland, or through unknown causes. In some cases, surgery, radiation or chemotherapy to treat tumors can affect male fertility.
Undescended testicles. In some males, during fetal development one or both testicles fail to descend from the abdomen into the sac that normally contains the testicles (scrotum). Decreased fertility is more likely in men who have had this condition.
Hormone imbalances. Infertility can result from disorders of the testicles themselves or an abnormality affecting other hormonal systems including the hypothalamus, pituitary, thyroid and adrenal glands. Low testosterone (male hypogonadism) and other hormonal problems have a number of possible underlying causes.
Defects of tubules that transport sperm. Many different tubes carry sperm. They can be blocked due to various causes, including inadvertent injury from surgery, prior infections, trauma or abnormal development, such as with cystic fibrosis or similar inherited conditions.
Blockage can occur at any level, including within the testicle, in the tubes that drain the testicle, in the epididymis, in the vas deferens, near the ejaculatory ducts or in the urethra.
Chromosome defects. Inherited disorders such as Klinefelter’s syndrome — in which a male is born with two X chromosomes and one Y chromosome (instead of one X and one Y) — cause abnormal development of the male reproductive organs. Other genetic syndromes associated with infertility include cystic fibrosis, Kallmann’s syndrome and Kartagener’s syndrome.
Problems with sexual intercourse. These can include trouble keeping or maintaining an erection sufficient for sex (erectile dysfunction), premature ejaculation, painful intercourse, anatomical abnormalities such as having a urethral opening beneath the penis (hypospadias), or psychological or relationship problems that interfere with sex.
Celiac disease. A digestive disorder caused by sensitivity to gluten, celiac disease can cause male infertility. Fertility may improve after adopting a gluten-free diet.
Certain medications. Testosterone replacement therapy, long-term anabolic steroid use, cancer medications (chemotherapy), certain antifungal medications, some ulcer drugs and certain other medications can impair sperm production and decrease male fertility.
Prior surgeries. Certain surgeries may prevent you from having sperm in your ejaculate, including vasectomy, inguinal hernia repairs, scrotal or testicular surgeries, prostate surgeries, and large abdominal surgeries performed for testicular and rectal cancers, among others. In most cases, surgery can be performed to either reverse these blockage or to retrieve sperm directly from the epididymis and testicles.
Environmental causes
Overexposure to certain environmental elements such as heat, toxins and chemicals can reduce sperm production or sperm function. Specific causes include:
Industrial chemicals. Extended exposure to benzenes, toluene, xylene, pesticides, herbicides, organic solvents, painting materials and lead may contribute to low sperm counts.
Heavy metal exposure. Exposure to lead or other heavy metals also may cause infertility.
Radiation or X-rays. Exposure to radiation can reduce sperm production, though it will often eventually return to normal. With high doses of radiation, sperm production can be permanently reduced.
Overheating the testicles. Elevated temperatures impair sperm production and function. Although studies are limited and are inconclusive, frequent use of saunas or hot tubs may temporarily impair your sperm count.
Sitting for long periods, wearing tight clothing or working on a laptop computer for long stretches of time also may increase the temperature in your scrotum and may slightly reduce sperm production.
Health, lifestyle and other causes
Some other causes of male infertility include:
Illicit drug use. Anabolic steroids taken to stimulate muscle strength and growth can cause the testicles to shrink and sperm production to decrease. Use of cocaine or marijuana may temporarily reduce the number and quality of your sperm as well.
Alcohol use. Drinking alcohol can lower testosterone levels, cause erectile dysfunction and decrease sperm production. Liver disease caused by excessive drinking also may lead to fertility problems.
Tobacco smoking. Men who smoke may have a lower sperm count than do those who don’t smoke. Secondhand smoke also may affect male fertility.
Emotional stress. Stress can interfere with certain hormones needed to produce sperm. Severe or prolonged emotional stress, including problems with fertility, can affect your sperm count.
Weight. Obesity can impair fertility in several ways, including directly impacting sperm themselves as well as by causing hormone changes that reduce male fertility.
Certain occupations including welding or those involving prolonged sitting, such as truck driving, may be associated with a risk of infertility. However, the research to support these links is mixed.
Risk factors
Risk factors linked to male infertility include:
Smoking tobacco
Using alcohol
Using certain illicit drugs
Being overweight
Having certain past or present infections
Being exposed to toxins
Overheating the testicles
Having experienced trauma to the testicles
Having a prior vasectomy or major abdominal or pelvic surgery
Having a history of undescended testicles
Being born with a fertility disorder or having a blood relative with a fertility disorder
Having certain medical conditions, including tumors and chronic illnesses, such as sickle cell disease
Taking certain medications or undergoing medical treatments, such as surgery or radiation used for treating cancer
